Although ALD is the most common liver disease in the Western world, it largely remains underestimated and underdiagnosed for many reasons. Screening tools for ALD such as ultrasound imaging or routine laboratory testing can overlook as much as 40% of manifest alcoholic liver cirrhosis. The recent introduction of noninvasive elastographic techniques such as transient elastography (TE, Fibroscan) and CAP have significantly improved the early diagnosis of alcoholic cirrhosis and fatty liver. Present algorithms allow either the exclusion or the exact definition of fibrosis stage. These new algorithms are discussed to monitor and screen ALD patients at high risk to rapidly progress to cirrhosis. Finally, it is expected that the novel technologies will allow a better abstinence programs or the validation of drugs such as Nalmefene to support alcohol-reduction approaches. First preliminary data of the DELIVER study will be discussed where TE and CAP have been explored to follow up nalmefene treatment to reduce drinking levels. At present, in 2016, it is no exaggeration to claim that non-invasive fibrosis screening should become mandatory in addiction centers.